A weight off the shoulders: Indian surgeons successfully removed 1.87kg brain tumour from 31-year-old man

Ho Jing Ting, 05 Mar 2018

Santhal Pal, 31, before and after his surgery to remove a brain tumour at Nair Hospital in Mumbai. Photo credit: Department of Neurosurgery Topiwala National Medical College, Nair Hospital/The Washington Post

Last month, a team of Indian surgeons at Mumbai’s BYL Nair Hospital, successfully removed a massive brain tumour, weighing 1.87kg from a 31-year-old shopkeeper, Santhal Pal. Experts believed it could be the largest brain tumour in the world.

The tumour, measuring 30 x 30 x 20 cm, was so large it seemed “like a head on top of another head”. It emerged from Pal’s skull three years ago; but, only grew exponentially over the past year.

“In a month, it grew over an inch,” said Akhilesh Pal, his brother. “He would feel a heaviness in his head, which ached constantly, and his vision was blurred.”

Risky operation to remove “second head”

The operation took six hours and required 11 bottles of blood to compensate for the risk of massive blood loss. Pal remained in the intensive care unit, connected to a ventilator, for three days after the surgery. Upon the successful removal of the tumour, a biopsy was carried out to determine the malignancy. Doctors are still waiting for the results.

“Now it’s a matter of recovery, but he’s out of danger," asserted Dr Trimurti Nadkarni, head of the neurosurgery department at Nair Hospital said.

Detailing the obstacles of the operation, Dr Nadkarni explained that “the tumour sat like a head on top of another head. We had to cut through the bone. The sheer size of the tumour was a challenge and we had to ensure blood pressure was maintained while surgery was on.”

Possibly world’s largest tumour to date

The tumour could be the largest to be removed from a brain in medical literature globally, according to some doctors in Nair Hospital. The case has yet to be cited in any medical journal. Previously, two similar cases were recorded, one in KEM Hospital in 2002 for the removal of a 1.4kg tumour and another at Sir Gangaram Hospital, New Delhi, in 2008 – when a tumour measuring 16 x 10 x 8 cm was removed from a woman’s brain.

Pal, from Allahabad, was put through sessions of chemotherapy when the tumour started growing. But, the mass continued to grow instead. He sought for surgery at three other hospitals – but was turned away, according to his wife.

He was then put through a series of CT angiography, CT scan and MRI, which revealed the blood vessels in his brain had grown into the tumour – providing fresh blood supply to the tumour cells. The tumour had also entered part of his brain and begun growing outside the skull bone.

According to doctors, only 10% of the tumour grew within the skull, but the pressure caused by the massive tumour on Pal’s brain has led to a loss of vision. Further pressure from the brain tumour could have led to complete paralysis and neurological damage.

To make matters worse, Pal is anaemic. If allowed to grow, the tumour could have led to vascular steal – where the blood flow gets diverted from the brain to the tumour – which could be fatal, emphasised the doctors at Nair Hospital.

Now, Pal anxiously awaits the results of the biopsy report.

“His recovery greatly depends on the nature of the tumour. If it is cancerous, he may need further treatment, such as radiation and/or chemotherapy,” said Dr Nadkarni.

The hospital reported that the patient had made a good recovery and can now walk and eat normally. Doctors hope his vision which was previously affected by the tumour would return with time. MIMS

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